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03110007CITY OE CUI'ER'fINO +��`"'�"'•* "" �'� '^`' F a+�avxL' BUILDING DIVISION PERMITCONTRACTnR`INFORMATIONu�_ Is BUILDING ADDRESS: . I VTMrqnT�RY PT MORTON FINHILL PERMIT NO. 03110007 -2—r44 " ER'S NAME: MORTON PTN14TT.T. PERMITMUEDATE 2 ONE: SANITARY NO. CONTROL N0. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hcmby affirm that 1 am licensed under provisions of Chapter 9 (commencing P with Section ]") of Division 3 of dm Business and Profession Code, and my license, is Lorane Class ermrf License f Class Lk. N REVISION --IN HOUSE USE ONLY Dam Centimeter NO NEW PERMIT ISSUED ORIG. 403010060 ARCHITECTS DECLARATION 1 understand my plans shall be used as public meet& Licensed Professional j OWNER -BUILDER DECLARATION 1 hereby from ohm I oro exempt room the Comranora License Law (.,,he i following reason. (Section IIA L5, Busincss and Professions Code: Any city or county which requires a permit to construct. alcor, improve. dcm ltvdi. of repair any structure ! priori its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant n the pmvisien of the Contmcturs Liwnse Law (Chapter 9 Sq. Ft. Floor Area Valuatio$1O7 (commencing with Section 7") of Division 3 of the Business and Professions Code) or . that he is eaempp therefrom and the basic for the alleged exemption. Any violation of 3 �,�A@19eI p p Occupancy P Y Type Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty Of not mom than five hundred d.11... (SK(B. 0 1, as owner of the property, or my employ. with wages as mei, to compensation, will dome work. and me structure is not intended or offcmd forsale (Sec. 7044, Business Required Inspections and Prefrssions Codc: The Contractor's License Law don not apply to an owner of property who builds or burrows thereon, and who docs such work himself or through his own employees, provided thauuch improvements are not intended or offered forsale. If. howcwt, the building or improvement is sold within one year of completion. the Owner - builder will have the burden of proving that he did not Wild or improve for purpose of sok.). co 1, t owner of the property, . B exclusively contracting with:)cursed cnnuanars t. comma the Business and Professions Code,:) The Conmrecor. Li. not (Sec. I \ come es does not apply m an owner of property who Wildspor improves thcmon. and o an Q who claw who contacts for such projects with a eonoaaor(s) licensed pursuant to me Contractor's Liamm Lbw. / Q 1 extrafitu�nsder Scc. B & P C for this reason �ND Date P W 5 COMP N A DECfA S I hereby affirm under Penalty of perjury one of the wing declaration: I haw and will maintain a Certlficam' of Consent to self -insure for Worker's Compen- troom, Us provided for by Section 3]00 of the Labor Code . for the Performance of the work for which this Permit is issued. 0 1 have and will maintain Wearkcr's Compensation In,..... as required by Section 3900 of me Labor Code,, for the performance of the work for which this Kim it is issued. My Workers Compensation Insurance artier and Polity number are: , Cartier. Policy No.: ' CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (Tbis.ection need not W comPlcmd if the permit is for one hundred dollars (g IOIB or less) 1 certify mat in the perfnm.m. of the work for which this permit 0 issued. 1 shall not employ any person in any manner u as tir Wemoc subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making this C(ertircam of Eaompion, you shouW become subject to the Worker'a Compensation provisions or the labor Code, you must ' forthwith comply with such Provisions or this Permit shall be deemed revoked. j CONSTRUCTION LENDINGAGENCY lending agcnry for Ne, perfurmance of 1 hereby.'whi thi mat mem is h s ed (Sect3 ' the work fur which this permit is issued (Sec. l09], Civ. C.) Lender) Name Lcndcri Address 1 coniry that I have read this application and suite that the above orom atiun is \ correct. 1 agree pc comply With city and county and ser laws relating and hereby amhorim maLlwSeca ematisxs of this city to enter upon the y t a �- 11wwngeontinsd ue ) alwve-memioned properly, forimpection purposes trabsk (We,) agree I. ssrc, indemnify and keep haomleas the City or Cupertino against - j in re coauand expenses which may in any way accrue against said City m eonsequcnce o )the granting of exphis permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date OURCEREGULATI NS. _ Re -roofs Signature ofAp licanveontracmr D e HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupam store or handle hazardous material u defined by the Cupemor Municipal Code. Chapter 9.11, and the Health and Safety Code Section 15532(.)? 0Yes All roofs shall be inspected prior to any roofing material being installed. Will ft applicantorfulumbuilding Occupant use equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove mit crncd by the Bay Area Air Quality Management us air comamiHirials all new materials for inspection. District, ❑ Yes I have mad the hrurequirements under Chapter 6.95oftheCal ifnr- at- Hcalth S Safety Code. Redum 255(15.25533 and 25534.1 understand that if the Wilding dors not eurmmly haw a enam. Nat it is my respmtsibility m nobly the occupant of the mgdirrmenttwhich Must xmet �orluisa aeur,Canirrcamofoccupanry. Signature of Applicant Date i All roof coverings to be Class "B" or better Owner or as rued agent Date